Provider Demographics
NPI:1033315684
Name:KOZAK, NICOLE DIANE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:DIANE
Last Name:KOZAK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 LINCOLN AVE TRLR 33
Mailing Address - Street 2:
Mailing Address - City:PLATTSMOUTH
Mailing Address - State:NE
Mailing Address - Zip Code:68048-2610
Mailing Address - Country:US
Mailing Address - Phone:402-296-0669
Mailing Address - Fax:
Practice Address - Street 1:1904 LINCOLN AVE TRLR 33
Practice Address - Street 2:
Practice Address - City:PLATTSMOUTH
Practice Address - State:NE
Practice Address - Zip Code:68048-2610
Practice Address - Country:US
Practice Address - Phone:402-296-0669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20789164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse